Title Page

  • Audit Title

  • Store Number

  • Location
  • Conducted on:

  • Conducted By:

Front of House

  • Floors in good condition, dry and maintained? Not slippery? Documented wet/dry inspection conducted prior to all rush periods?

  • Portable warning systems available to indicate wet floors or temporary hazards?

  • Carpet/ walk off mats used at entrances with no raised edges and dry?

  • No water leaks from ice chest or ice machines?

  • Anti-slip shoes worn by all employees?

  • Dining area / equipment clean and in good repair? Chairs? Tables? Carpet? Flooring?

  • Exterior of building in good repair? Including parking lot? Back Loading area?

Restrooms

  • CLEAN: Doors, threshold, corners, sink, toilet, light fixtures, floors, baseboards, ceilings, walls, vents, trashcan, odor free

  • Toilet, Sink, Soap Dispenser and covered trash receptacle all working properly

  • Paper goods stored correctly

  • Employee Hand Washing Signs Posted?

  • Sanitary Disposal: Available, clean and working properly

Back of House

  • Floors in good condition, dry and maintained? Not slippery? Documented wet/dry inspection conducted prior to all rush periods?

  • Anti-slip shoes worn by all employees?

  • Counters, racks, beverage area, etc. in good repair free of rough or sharp edges and corners?

  • Compressed gas cylinder secured to the wall? Or otherwise protected?

  • No water leaks from ice chest or ice machines?

  • Grease producing cooking equipment receptacles emptied regularly?

  • Is hood and duct over cooking equipment clean and free from grease buildup? Are filters in place, are they clean? No gaps?

  • Oven mitts available and in good condition? Forearm length?

  • Are cut gloves available for use, especially during mandolin use, oysters ? Are various sizes available?

  • Is knife training provided to employees? Are safe knife practices being followed?

  • Are extra knives properly stored in sheaves or other means to protect from the blade while in storage?

  • Is Hobart Mixer equipped with a bowl guard?

  • Proper tools (self closing box knives, etc.) provided and used to open crates boxes barrels and other containers?

  • No storage within 36 inches of the water heater or 18 inches of sprinkler heads?

  • Ladders or stepstools available to reach overhead stock? Ladders or stools are in good condition? Ladders or stools are sufficient height to eliminate overhead reaching?

  • Are all chemicals and cleaning agents stored away from food? Are they properly labeled and sealed?

  • Are clear pathways maintained during receiving of products?

  • Are the ashes from the wood fired ovens disposed of properly? In a metal can? Allowed to cool before discarding?

Food Safety

  • Employees and Managers have had food safety training?

  • Is the QUAT concentration between 200 - 300?

  • Are QUAT test strips readily available?

  • Is the Victory Wash/AFVT concentration at 60?

  • Is the Victory Wash/AFVT test strips readily available?

  • Is Victory Wash/AFVT used on all produce & fruit even if pre-washed?

  • Is the State of MN Food Safety License Posted for Chef and GM?

  • City Food / Sidewalk Cafe / Delivery Vehicle Licenses posted

  • Is the Beer/Wine license posted?

  • All hand sinks clean, stocked and in working order? Nothing blocking hand sink access?

  • Proper hand washing evident by all staff. Turn off sink with hand towel.

  • Are gloves used on all ready to eat foods?

  • Is all food stored 6” off floor?

  • Are all chemical bottles properly labeled & stored away from food?

  • Are employee beverage stored with lids & off the line in designated area?

  • No personal items anywhere on the lines including beverages

  • No grazing

  • Daily Safety Log filled out correctly and completely every day

  • Illness log completed

  • Pass health inspections and Betty Packer reports with no Critical Violations?

  • Sense of urgency shown in follow-through action on above reports

  • Proper cooling Log used and proper heating procedures followed

  • Proper rotation of dry food. FIFO (Chips, soda)

  • Cutting boards clean and in good condition

  • Box Lunch Procedure Posted and Followed

  • Line staff demonstrates knowledge of Food temp safety

  • Document the Temperature:

  • Ask staff what temperature hot foods need to be stored at: Document their answer:

  • Ask staff what temperature hot foods need to be reheated to for 1 minute for before being served: Document their answer:

  • Food handled with patty paper, tongs or gloved hands

  • Are all designated chefs equipped with thermometers as part of their uniform? Or are thermometers available for checking food temps?

Deli / Pastry Cases

  • Is the salad case clean and in good repair: doors, sides, cracks, front, bottom

  • Is the sandwich case clean and in good repair: doors, sides, cracks, front, bottom

  • Is the pastry case clean and in good repair: doors, sides, cracks, front, bottom

  • Are proper pastry rotation and shelf life rules being followed?

  • Are chilled platters used in the case?

  • Proper Registered Case Temperatures: (Please Temp at least three cases)

  • Sandwich, Salad, Pastry
  • Name of case Temp'd:

  • Document the Temperature:

  • Proper Item Temperatures: (Please Temp at least three items)

  • Sandwich, Salad, Pastry
  • Name of Item Temp'd:

  • Document the Item Temperature:

Service Line

  • CLEAN: Ceiling, walls, floors, corners, baseboards, under racks, shelving and speed racks

  • Green Soapy water bucket clean and in use with blue towels on service line.

  • Red Sanitation bucket clean and in use with blue towels on service line. Proper PH

  • Service staff demonstrates knowledge of Monthly Features

  • All Staff demonstrate knowledge of Proper PH

  • Thermometers in reach-in coolers in sight?

  • Document Cooler Temperatures:

  • Cooler Location
  • Location of Cooler / Name:

  • Document the Temperature:

Cooks Line / Prep Area

  • CLEAN: Ceiling, walls, floors, corners, baseboards, under racks, shelving and speed racks

  • Green Soapy water bucket clean and in use with blue towels on service line.

  • Sanitation bucket clean and in use with blue towels. Proper PH

  • Proper storage of multi-use tools such as tongs and spatula's. No cross-contamination possible.

  • Line staff demonstrates knowledge of Monthly Features

  • Sign's indication Prep Sink Only

  • 2+ Digital Thermometer's available to all staff and calibrated weekly.

  • Proper storage of raw and cooked product in all coolers.

  • Pizza Rail Top & Reach-in Closed in down times?

  • Document the Temperature:

  • Entrée Rail Top & Reach-in Closed in down times?

  • Document the Temperature:

  • Freezer Reach-in Shut in down times?

  • Thermometers in sight in all reach-in coolers?

  • Document the Temperature:

  • Pizza oven clean inside and out?

  • Document the Temperature:

  • Pot handles on stove turned in and away?

Walk-In Cooler

  • Document the Temperature:

  • CLEAN: Ceiling, walls, floors, corners, baseboards, under racks, shelving and speed racks

  • Refrigerated Storage Form Posted

  • Proper storage of raw and cooked product in all coolers. No cross-contamination possible.

  • All refrigerated product properly stored. Are products being FIFO, are products labeled with use by dates? Are prdoucts being labeled with day dots?

  • Cooling Wand in use or in Freezer wrapped in plastic wrap.

  • Shallow Pan Cooling Evident

  • No expired product

  • All items labeled with use by dates

  • Freezer and cooler interior door latch in working order? Lights provided with protective globes?

Dish Area / Mop Room

  • CLEAN: Ceiling, walls, floors, corners, baseboards, under racks, shelving and speed racks

  • SDS or "Right to Understand" Station in order. Staff shows a proper understanding of all chemicals used in the restaurant

  • Proper chemical storage and dispenser in working order

  • Dish Machine, shelves, backsplash & sprayer head clean and operable

  • Proper dishwashing procedures adhered to. Test strips used daily. Water changed at least 3 times daily

  • Mop room/sink clean; corners, floors: mop/broom/dustpan hung & in good condition, pails rinsed

  • Ice machine & filter clean, proper scoop & blue bucket storage

  • First Aid kit well stocked. Blood Pathogen Kit available

Lifting / Manual Material Handling. / Ergonomics

  • Are carts/wheels of moveable equipment in good working order? Are they free moving or do they require extra force to move?

  • Training on proper lifting techniques?

  • Heavy or bulky items stored on shelves between knee and chest level? Lighter items on top?

  • Task so arranged to prevent over reaching, awkward movements, or constant bending?

  • Job Rotation for repetitive tasks?

  • Ergonomically designed tools being used? Fatigue Mats for prolonged standing?

Emergency Action Plan

  • First aid kit available for emergencies? Adequately Stocked?

  • Is at least one person per shift trained in First Aid / CPR / AED Use? Including first aid for choking?

  • Do Employees know where to locate & how to operate Emergency Gas Shut Offs?

  • Remote release for the automatic extinguisher accessible and known to employees?

  • Do employees know where to go in the event of an emergency? Fire, Tornado, Hurricane, other?

  • Automatic fire protection system over cooking equipment inspected and serviced by a qualified person in the last six months with rubber caps in place?

  • Fire extinguishers identified by class and service yearly? One class 10 BC near cooking equipment into class ABC in other areas?

  • Are Emergency Exits blocked?

Electrical Equipment

  • Extension cords prohibited from use as a substitute for permanent fixed wiring?

  • Electrical panel readily accessible? Cool to the touch? Panel door closed? No storage in front of the panel (keep clear 36")?

Miscellaneous

  • Are there any additional hazards that need to be documented?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.